issue 176 - October 1987
'They call it la operación'
A Puerto Rican woman in New York is twice as likely
to be sterilized as a black woman - and ten times more likely
than a white woman. Annette Fuentes investigates the
unusual popularity of 'la operación'.
Esperanza went to her doctor at the end of July to ask about birth control. She and her husband already have two children and do not want to have another just yet. He works in the cafeteria at Hartford Hospital in Connecticut. The job is steady, but it doesn't pay a great deal and it is a struggle to pay the bills and keep a roof over their four heads.
The doctor, a private practitioner, didn't spend too much time talking about temporary birth control methods. He just suggested that sterilization would be the answer to Esperanza's prayers. What he didn't tell her was that it was permanent. He said that if he tied her fallopian tubes, they would simply come untied after five years and she would be able to have children again.
That all sounded good to the young Puerto Rican woman. She hoped for a more prosperous future and, after all, lots of women she knew had already had Ia operación - they call it la operación, the operation, because it is so common. So Esperanza agreed to become operada. Two weeks after she was sterilized, Esperanza learned the truth.
'It happens all the time,' says Dr Joseph Millerick, head of the obstetrics and gynaecology department at Hartford Hospital. 'It's not as bad as ten years ago. But Puerto Rican women who were sterilized in Puerto Rico still often want to have the operation reversed. They believe reversal is simple.' But reversal operations, which are rarely successful, cost thousands of dollars - beyond the reach of the vast majority of women who want them.
That this should happen to even one woman is cause for concern. But it seems that Esperanza's story is probably more the exception than the rule. This is largely because of federal guidelines on informed consent drawn up in 1975 as a result of pressure from activists like Dr. Helen Rodriguez. 'There is continuing sterilization,' she says. 'But hospitals have cleaned up their act. The problem today is that Puerto Rican women now use sterilization as their main method of birth control.'
Five decades of experience with sterilization have left a lasting legacy in Puerto Rico. In 1968 35.3 per cent of all Puerto Rican women of child-bearing age had been sterilized, many without fully understanding the finality of the operation, many others without their knowledge at all. Today experts put the figure at 45 per cent or even higher, making it the highest rate in the world. Despite this incredibly high total, sterilization rates have not declined. On the contrary, la operación has become entrenched, even institutionalized, among Puerto Rican women wherever they live. Says anthropologist Iris Lopez: 'It is now a tradition and women are getting sterilized at earlier ages than ever before.'
In New York, for instance, which has the largest Puerto Rican community in the US, Puerto Rican women are twice as likely to be sterilized as black women - and ten times more likely to be sterilized than white women. A study in Hartford, where Esperanza lives, reveals that 50 per cent of Puerto Rican women of child-bearing age have had Ia operaclón.
Why is it, then, that these women are opting for la operación in such large numbers - and at younger and younger ages? It is a question that plagues Esta Armstrong, who organized the committee that created the city's informed-consent guidelines. Part of her job involves monitoring the city's 11 hospitals for instances of abuse. The guidelines require that the patient be at least 21 years old, must be told about other forms of contraception - in her own language - must then sign a consent form and then wait 30 days in case she wants to change her mind.
'What is startling about our review of procedures is that everything is being done properly in the hospitals. So you have to wonder why Puerto Rican women aren't using other types of contraception. If women have been given the information, we can't then tell them they can't be sterilized.'
But freedom of choice is a relative thing for all women - and for Puerto Rican women that freedom is further conditioned by their history as a people colonized by the US. Sterilization was made legal in Puerto Rico in 1937, when the eugenic movement in the US was in full swing. Mass migration of Puerto Ricans to the mainland in the I940s, sparked by the new jobs in the burgeoning factories and plantations, caused a backlash among American whites who feared this influx of ethnically and often racially different people. By the 1950s, population control had become a burning issue and Puerto Rico was used as a laboratory for some of the first scientific experiments in birth control (the pill was field-tested there for the first time in the late 1950s). In the early 1960s the US began funneling funds to Puerto Rican clinics and eventually sterilization, alongside strict migration controls, became twin pillars of a wide-ranging US policy to control the Puerto Rican population. So successful was the approach that the growth rate of the Puerto Rican population fell from 2.7 per cent in the 1950s to 1.7 in 1980.
The justification for programs like this has always been that the best way to deal with poor people is to limit their numbers. But this has clearly not worked because between 69 and 80 per cent of woman-headed Puerto Rican households in New York are living below the poverty line.
'The trouble is that poor women have so few options,' says Iris Lopez. 'One more kid could break them financially.' She has been studying a Puerto Rican community in Brooklyn, New York, where 47 per cent of the women have been sterilized, and has discovered yet more ways in which their choices are being eroded: 'Now abortions are so restricted, they are even more likely to choose sterilization.'
Since 1980 the US Medicaid program, which helps poor people with their medical bills (health care is not free in the US), has refused to pay for abortion but continues to cover 90 per cent of the costs of Ia operaci6n. Access to other family-planning services has also been reduced and services with bilingual staff are increasingly hard to find, so misunderstandings are likely to become commonplace once more.
But the institutional emphasis on sterilization maybe a needless overkill, because other forms of preventing pregnancy just don't seem to appeal to Puerto Ricans. 'There's a large number of women aged between 21 and 25. Most have their kids early and decide to be sterilized because they don't trust the pill and don't like the diaphragm,' says Herminia Cruz, who works at a clinic within Hartford Hospital. 'We suggest condoms, but it is a very macho society and the men don't come to the clinic. Women have to deal with birth control alone.'
Iris Lopez' study backs this up. She found that 76 per cent of women used some form of temporary contraception before getting sterilized, but that they expressed dissatisfaction with what was available - especially the pill and the IUD. She also found that Puerto Rican women are being sterilized at younger ages than any other group: 'White and black families tend to be sterilized between 30 and 34. But the largest number of sterilized Hispanic women were aged between 25 and 29.'
'I wish I could see the woman before she has that second baby,' says Herminia Cruz. 'Then maybe she could make a decision about sterilization before being forced into it by her economic reality. When I see women so young - aged 21 with five kids - there's great pressure to do something. But what is really needed is early intervention.'
'Early intervention' would have to include more than just counselling about contraception, however, as Digma Sanchez of the New York Committee on Hispanic Children and Families explains: 'Sterilization is an easier solution than finding jobs, better education, affordable housing. Women feel life is so difficult, why not get sterilized?'
Annette Fuentes writes for the New York daily paper El Diario and is co-author of Women in the Global Factory (Boston, South End Press, 1984).
ANC WOMEN'S SECTION,
I represent the African National Congress, the vanguard movement fighting for the liberation of the people of South Africa. I represent millions of women in South Africa who are denied all basic human rights including reproduction rights. This denial is exposed by the strategy of 'family planning' in our country, which is nothing more than a pillar of the apartheid programme.
Back in 1956 Philip Moore declared that: 'A massive birth-control programme is the only action that will permit European survival and at the same time be acceptable to the rest of the world'. This is the Ideology which underlies the aggressive population-control programme launched by the regime in 1974 and based on recommendations of the Symposium on the Population Explosion in South Africa. The Symposium was at pains to stress that it was the black majority who were to be the prime targets of any campaign.
In 1972 there were fewer than five fulIy trained family planning doctors in South Africa. By 1976 at least 1,221 staff had been recruited. The programme began with a scheme to distribute the pill, free of charge, to all women. However the pill is the method least preferred by the population controllers because it is taken at the discretion of the user. The RID comes closer to meeting usually remains in place until it is removed by a trained person. One technique is to fit the IUD while a woman is being given what she believes to be a routine pelvic examination. A preferred alternative - also extensively administered to black women with or without their knowledge or consent - is the contraceptive injection, Depo Provera, which is banned in many Western countries but made available in South Africa by Upjohn Belgium.
But sterilization is the ultimate means of ensuring effective population control. The Abortion and Sterilization Act of 1975 stipulates that written consent of the person who in law consents to an operation has to be obtained before a sterilization is performed. But the overwhelming majority of black women have the legal status of children. This means that their own consent is not required, thus making their involuntary sterilizatlon perfectly legal in South Africa. Today the white élite is exhorted to 'educate the blacks they come into contact with'. The magazine Fair Lady carries an advertisement in which a white woman addresses the reader: 'I discuss family planning with my domestic and take her to the nearest clinic. Apart from helping her, I have also helped myself with a domestic who is more efficient and devoted because her mind Is free of family problems'. Both industry managers and farmers show films and Invite medical advisors to give lectures to their workers. The question of whether the workers wish to co-operate becomes secondary as unwillingness carries with it the threat of losing their jobs.
In terms of the success of the programme, the 1976 statistics are very revealing: 90 per cent of the black target population were 'protected' as opposed to only 22 percent of the white target population. We, the women of South Africa, are not against family planning. But there is a difference between women demanding family planning and women compelled to accept population control.
From a presentation at the Women's Reproduction Right Conference in Amsterdam 1984